Apolipoprotein B and Coronary Artery Disease in Indian Population.

Vimalraj, B S (2007) Apolipoprotein B and Coronary Artery Disease in Indian Population. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION : The association between serum cholesterol levels and atherosclerosis in humans was suggested when Thannhauser and Muller in 1938 demonstrated familial aggregation of individuals with tendon xanthomata, hypercholesterolemia, and CAD. The association was generalized by studies such as those in Framingham, which demonstrated that the risk for coronary artery disease rose over the entire range of serum cholesterol. This relation was seen predominantly in those persons 30 to 49 years of age at entry into the study and most markedly in those 30 to 39 years old. AIM : To study the association between plasma apolipoprotein B (apo B) and angiographically proven Coronary Artery Disease (CAD) in a prospective manner. BACKGROUND : The plasma apo B concentration represents the number of atherogenic lipoproteins and it has been demonstrated that it could be a predictor for CAD. This study was done to find out whether apo B is an independent risk factor for CAD and whether apo B is superior to routine lipid profile in differentiating patient with CAD. Materials and Methods : The study population consisted of both men and women who were undergoing their first angiography between March 2004 and December 2005. A total of 200 consecutive patients were enrolled. Patients were divided in to 2 groups; Group 1: Patients with angiographically proved CAD were included. Group 2: Patients with normal coronary angiogram or patients with negative stress testing by treadmill. After an overnight fasting, blood samples were taken for lipids and apo B. Baseline characteristics such as hypertension, diabetes, and smoking were taken from all the patients. A patient was said to have CAD (CAD+) if there was an angiographic lesion more than 50%. A patient was considered as control (CAD-), if angiogram was normal or treadmill stress testing was negative. RESULTS : A total of 200 patients were enrolled. There were 155 males and 45 females in the study. There were slightly more number of males in group 1. The total cholesterol was higher in patients with CAD when compared to controls. When we use the cut off value of 150mg or above as hypertriglyceridemia, then 52% of CAD patients were found to have higher values compared to controls, which was only 35%. For a cut off value of LDL less than 130mg%, it was found that 94% of controls and 83% of patients with CAD had lower values. The median apo B values in patients with CAD were 1.07g/L, versus in controls 0.79g/L, which was statistically significant. We calculated Receiver Operating Curves (ROC) to assess the sensitivity and specificity of apo B in identifying a patient with CAD. For a cut off value 0.99 g/L, it was found that the sensitivity was 66% and specificity was 92%. The area under the curve was 0.814. CONCLUSION : Our results suggest that apolipoprotein B provides better information regarding the presence of CAD. Higher apo B values were noted even in those patients with CAD with normal levels of LDL. In patients who were on statins only apo B was able to predict the presence of CAD. Apo B is a better predictor for CAD than routine LDL levels.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Apolipoprotein B ; Coronary Artery Disease ; Indian Population.
Subjects: MEDICAL > Cardiology
Depositing User: Kambaraman B
Date Deposited: 10 Jul 2017 05:41
Last Modified: 10 Jul 2017 05:41
URI: http://repository-tnmgrmu.ac.in/id/eprint/1263

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